Just had a meeting with the key players working on the development of an Alliance Model for General Practice working alongside CPFT, CHOC and UCLAN. It’s an ambitious attempt to rebuild general practice to a more resilient and flexible model. I hope it succeeds.
It all depends on the ability to attract and retain a critical workforce of GPs and other practice staff to keep services viable across a number of practices. It relies on such staff being attracted by a greater experience than they would get in a traditional practice by offering portfolio careers and opportunities to work “at scale.”
The proposal is that a practice will retain its GMS contract and the partners will be accountable to the CCG for the operation of this contract. However, where it differs from the traditional model is that the partners would then sub contract the delivery of the service to a not for profit company – “North Cumbria Primary Care Collaborative.” This organisation would employ all the staff at the practice, including the GPs. The model also envisages the organisation taking on the premises, either as owner or by taking on the lease.
The key to the arrangement is the relationship between the practice partners and the “North Cumbria Primary Care Collaborative” What governance arrangements will be put in place to define the responsibilities of the “Partners” and local management arrangements as opposed to the responsibilities of the overall Collaborative. It is understood the Collaborative will have a Board and there will be representatives from member practices on that Board. There will inevitably be some loss of local sovereignty as the Board will be concerned with the overall viability and success of the Collaborative.
And what if there is a breach of contract due to some unforeseen event or circumstances. As the Contract is still held by the partners with the CCG any conversation will be between these two entities. However the Partners will then need to turn to their Collaborative with whom they have sub contracted to find a remedy. What is important here is the exact nature of that sub contract. Who is accountable to whom, and for what, remains to be worked out.
Over the next few weeks the governance and contractual arrangements are being developed. We all need to see this detail before anyone can sign up with confidence. The LMC is happy to work with all stakeholders to achieve a good solution that preserves the best of general practice whist recognizing the workforce and workload challenges that face general practice in Cumbria.